The USMLE Step 2 CK is the final hurdle before Match, and marks the beginning of the end of medical school. There are different schools of thought on the utility of Step 2 CK. Some people try to use the exam to make up for shortcomings on Step 1, while others decide to delay CK until late in the Fall of 4th year, so their excellent Step 1 score isn’t at risk of be tarnished by a poor performance. I myself just wanted to get the darned thing over with. I wrapped up 3rd year feeling as if rotations had gone very well, so I took 2 weeks off in the middle of July to study, and took the exam thereafter.
Six long weeks of waiting went by before I got that magical email in my inbox — my score report with a glorious 284 on the Step 2 CK! So how did I manage such a high score?Here are 5 important tips to help you score high on the USMLE Step 2 CK:
1. Start Preparing Early
I believe my success on this exam started on Day 1 of medical school. The consistent study habits and solid foundation I developed in the M1 and M2 years carried over into clerkships and Step 2 CK. We have all heard the cliché about medical school being a marathon rather than a sprint, but it really does hold true. If you want to excel in medical school and crush the Step exams, you can forget those crumby undergrad study habits of slacking off in-between exams and ramping up during exam week. Instead, immerse yourself in medicine for the next few years and get used to studying long hour every day. You should be studying consistently enough that when exams arise there is no change in the intensity or duration of studying, rather there is simply a shift in focus from learning new material to reviewing material you have already learned.
If you’re reading this and are already over the Step 1 hurdle, regardless of your performance over the past two years, it is not too late for you to buckle down and work your tail off. Yes, the transition to clerkships and studying for CK is easier with a strong foundation in the basic sciences, but M3 year offers 365 days of opportunities to remediate weak areas and acquire new clinical knowledge.
2. Focus on Clerkships
Coming off a Step 1 score in the 270s, I undoubtedly was already looking ahead to Step 2 CK when clerkship rotations started. I had to suppress thoughts and concerns about matching or even topping my Step 1 performance, and instead set my sights on mastering the subject material presented in each rotation. I approached every clerkship with the mindset that I was considering that field as a potential career choice and attempted to learn all the basics needed to understand that field of medicine — this made me a better student and allowed me to make an honest assessment of my fit in each specialty when it came time to apply for residency. Each rotation had two specific goals; 1.) try to gain the knowledge and clinical reasoning to function at an intern level, and 2.) score as high as possible on each shelf exam.
I used a mix of review books and recommended textbooks to read for each clerkship, with a tendency more toward the recommended textbooks. Although review books are easier to read and full of high-yield information, I didn’t want to sacrifice quality for the sake of brevity. I concurrently completed the relevant sections in UWorld, taking notes along the way, so I could easily go back and review weaker areas. (If the concept of taking notes on UWorld is a new one to you, I would highly recommend the MST blog of The UWorld Journal.) I also chose to use a few of the specialty-specific question banks, particularly the ACOG uWise and the AAFP question banks. Lastly, I would take one of the NBME Clinical Science self-assessments the week before each shelf exam, just to make sure I was on the right track.
3. UWorld, UWorld, and… More UWorld
I had completed my first pass through UWorld by the end of M3 year and hit the reset button for one more go at it. I have a very intelligent friend who is now an internal medicine resident tell me she scored a 276 by doing nothing but UWorld for a few weeks. That sounded simple enough to me, so I decided to take the same approach. I took 2 weeks off to study for Step 2 CK and decided that time was going to be devoted almost entirely to UWorld questions. I had already been keeping some notes from my first pass through UWorld, but found that by this time in my medical training many of the topics in those notes were much more familiar than they had once been. This led to me essentially discarding the UWorld notes I had taken during my first pass and starting fresh. This time around I really focused on the diagnostic and treated algorithms presented in many of the UWorld explanations. I kept a legal pad next to my computer and would draw out every single algorithm I came across. When I was I sick of doing question blocks or reviewing questions, I would grab my legal pad, go sit on my back porch, and quiz myself on those algorithms.
Every once in a while, I would come across a topic I felt I needed a little more information on, so I had to decide what ancillary resource to reach for. I wasted about an hour on Step Up to Medicine’s electrolyte section before I became frustrated with the number of mistakes I found, and quickly abandoned that book. Moving forward, I decided to use UpToDate as my sole reference resource. UpToDate’s online search feature and clinical relevance made it the ideal reference when studying for Step 2 CK. For anyone who takes this approach I would caution them to use self-control, as the numerous links to various relevant topics can cause the reader to get lost in a clinical information wormhole of galactic proportions. Knowing I only had 2 weeks to cover an entire question bank helped keep me out of said wormhole.
4. Check Your Progress
Just like with Step 1 preparation, the NBME self-assessments were a great way to track my progress. There are only four of these practice exams, so I decided to take one a few weeks before the end of 3rd year to get a baseline. I took the remaining three exams during my study period and Form 6 predicted my exact score. These practice exams all had shorter vignettes than what is on the actual exam, but it was excellent practice to sit down and do questions under exam conditions.
5. Exam Day
Exam day is a long, with a lot of reading, so it’s all about pacing. I took the exam one block of questions at a time and left the exam for a snack and bathroom break between every single block. This helped me forget about any of the questions I had spent the past hour agonizing over and go into the next block with a blank slate. After doing thousands of practice questions I felt I had developed a pretty good sense for how long each question should take, so once that internal alarm went off, I would pick the answer I felt was the most correct and move on. In the end, neither fatigue nor timing was an issue. Like just about everyone I have talked to, I left the exam center with absolutely no clue what my score was going to be. I was pretty confident I had surpassed 250, but was unsure beyond that.
In the end, I can look back on the last 3 years of medical school and be very proud of the work I have put in. I don’t think I am some savant or talented test-taker, but rather I have worked very hard for my education. I find people sometimes are disappointed when I attribute my success to hard work, as if I were supposed to tell them some secret I had discovered. The truth is there are no shortcuts. Those looking for the easy way out will find this disappointing, and those willing to roll up their sleeves will find this encouraging. I hope you finish reading this article feeling encouraged. Hard work itself is incredibly rewarding, but as a bonus, it also feels good to have your efforts validated by two of the most feared standardized tests around.